Introduction: Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Homebased
voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.
Methods and Findings: We conducted a systematic review and random-effects meta-analysis of studies published between
1 January 2000 and 24 September 2012 that reported on uptake of HBT in sub-Saharan Africa, to assess the proportion of
individuals accepting HBT and receiving their test result. Our initial search yielded 1,199 articles; 114 were reviewed as fulltext
articles, and 19 publications involving 21 studies (n = 524,867 individuals offered HBT) were included for final review
and meta-analysis. The studies came from five countries: Uganda, Malawi, Kenya, South Africa, and Zambia. The
proportion of people who accepted HBT (n = 474,377) ranged from 58.1% to 99.8%, with a pooled proportion of 83.3% (95%
CI: 80.4%–86.1%). Heterogeneity was high (t
2 = 0.11). Sixteen studies reported on the number of people who received the
result of HBT (n = 432,835). The proportion of individuals receiving their results out of all those offered testing ranged from
24.9% to 99.7%, with a pooled proportion of 76.7% (95% CI: 73.4%–80.0%) (t2 = 0.12). HIV prevalence ranged from 2.9% to
36.5%. New diagnosis of HIV following HBT ranged from 40% to 79% of those testing positive. Forty-eight percent of the
individuals offered testing were men, and they were just as likely to accept HBT as women (pooled odds ratio = 0.84; 95% CI:
0.56–1.26) (t
2 = 0.33). The proportion of individuals previously tested for HIV among those offered a test ranged from 5% to
66%. Studies in which ,30% of individuals had been previously tested, local HIV prevalence was ,10%, incentives were
provided, or HBT was offered to household members of HIV-positive individuals showed higher uptake of testing. No
evidence was reported of negative consequences of HBT.
Conclusions: HBT could substantially increase awareness of HIV status in previously undiagnosed individuals in sub-Saharan
Africa, with over three-quarters of the studies in this review reporting .70% uptake. It could be a valuable tool for
treatment and prevention efforts.